Basic Information
| Provider Information | |||||||||
| NPI: | 1154323855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORWAY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | DIXON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1737 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891251737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026716809 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 3150 N TENAYA WAY | ||||||||
| Address2: | #260 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028702099 | ||||||||
| FaxNumber: | 7024070266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 09/23/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 3582 | NV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 002018189 | 05 | NV | MEDICAID | CS01857 | 01 | NV | STATE PHARMACY | OTHER | 003102189 | 05 | NV | MEDICAID | AD8135178 | 01 | NV | FEDERAL DEA REGISTRATION | OTHER | 3582 | 01 | NV | MEDICAL LICENSE | OTHER |